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. 2025 Jan 11;15(1):1696.
doi: 10.1038/s41598-025-85625-8.

The MRI-based vertebral bone quality score is a predictor of pedicle screw loosening following instrumented posterior lumbar fusion

Yung-Hsueh Hu #  1   2   3 , Jian-Hong Chou #  2   3 , Yu-Cheng Yeh  1   2   3 , Ming-Kai Hsieh  1   2   3 , Tsung-Ting Tsai  1   2   3 , Wen-Jer Chen  4 , Lih-Hui Chen  1   2   3 , Po-Liang Lai  1   2   3 , Chi-Chien Niu  5   6   7
Affiliations

The MRI-based vertebral bone quality score is a predictor of pedicle screw loosening following instrumented posterior lumbar fusion

Yung-Hsueh Hu et al. Sci Rep. .

Abstract

Objective: To investigate the predictive ability of the MRI-based vertebral bone quality (VBQ) score for pedicle screw loosening following instrumented transforaminal lumbar interbody fusion (TLIF).

Methods: Data from patients who have received one or two-level instrumented TLIF from February 2014 to March 2015 were retrospectively collected. Pedicle screw loosening was diagnosed when the radiolucent zone around the screw exceeded 1 mm in plain radiographs. The T1-weighted MRI sagittal images were used for calculation of the VBQ score. The score was calculated with the median signal intensity value of L1 to L4 divided by the signal intensity value of cerebrospinal fluid at the L3 level. Univariate analysis and multivariate binary logistic regression analysis were performed. Receiver operating characteristic curve analysis assessed the predictive ability of the VBQ score on screw loosening.

Results: Among the included 211 patients, 75 of them (35.55%) had pedicle screw loosening at the 24 month follow-up. Multivariable logistic regression analyses demonstrated that higher VBQ score (OR: 27.887 ± 0.514 ,95% CI: 10.189-76.326), male sex (female to male 0.323 ± 0.483, 0.126-0.833), and longer fusion length (2.578 ± 0.545, 1.166-5.701) were significant influencing factors for pedicle screw loosening. The VBQ score significantly predicted screw loosening with an accuracy of 78.9%.

Conclusions: A higher VBQ score was an independent risk factor for pedicle screw loosening following instrumented TLIF. The MRI-based VBQ score showed good predictive ability for screw loosening and could be used as an alternative option for preoperative bone quality evaluation.

Keywords: Bone density; MRI; Multivariable analysis; Pedicle screw loosening; Posterior lumbar fusion.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: This study was approved by the Institutional Review Board of Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. The need for patient consent was waived by the committee. (IRB: IRB202100894B0)

Figures

Fig. 1
Fig. 1
The anteroposterior (left) and lateral (right) radiographs of loosened pedicle screws. The arrows indicate the radiolucent zone. The vertebral body was divided into four parts for measurement of screw depth.
Fig. 2
Fig. 2
The demonstration of the VBQ score measurement in a representative noncontrast MRI T1-weighted sagittal lumbar image.
Fig. 3
Fig. 3
(A, B) Receiver operating curve (ROC) analysis and the area under the curve (AUC) of the VBQ score for the prediction of pedicle screw loosening. The circle indicates the cutoff point determined by the Youden Index.
See this image and copyright information in PMC

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